Respiratory pathophys Flashcards

1
Q

Upper respiratory

A

above the larynx
pharyngitis, otitis media, sinusitis

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2
Q

Lower respiratory tract

A

below the larynx
acute bronchitis, chronic bronchitis, pneumonia, TB

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3
Q

Defense mechanisms against infections, URT

A

nasal hairs, gag reflex, epiglottis, mucosal lymphoid tissue, secretory immunoglobulins

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4
Q

Defense mechanisms against infection, LRT

A

secretory IGA, ciliated epithelium, bronchospasm, cough reflex, alveolar macrophages

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5
Q

Conditions that impair host defenses

A

Cigarette smoking
Intubation
Recurrent laryngeal nerve damage
Absent gag reflex
Cystic fibrosis
Congenital absence of IgA
Oversedation

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6
Q

Cigarette smoking

A

paralyzes cilia, destroys epithelium, decreases number of macrophages, decreases macrophages’ activity

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7
Q

Intubation

A

impairment of host defenses, bypasses upper respiratory tract

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8
Q

Recurrent laryngeal nerve damage

A

at risk during surgeries
speech, swallowing, coughing

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9
Q

Absent gag reflex

A

1/3 individuals don’t have it, increased risk for aspiration

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10
Q

Cystic fibrosis

A

overproduction of thick sputum, risk for increased infection

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11
Q

Congenital absence of IgA

A

increased risk for infection

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12
Q

Oversedation

A

decreases ability to cough
usually occurs was opiates or other CNS depressants

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13
Q

Pathogenesis of lower respiratory tract infections

A
  1. nasopharyngeal colonization with the organism and subsequent aspiration of nasopharyngeal secretions
  2. reflux of GI bacteria and aspiration of contents in presence of antacid use
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14
Q

Acute bronchitis

A

D: inflammation of bronchial mucosa and increased endobronchial mucus production, due to infection
E: viral and seasonal
CP: dry cough or cough with purulent or mucoid sputum. myalgias, sore throat
T: no antibiotics

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15
Q

Pneumonias

A

inflammation of lungs with consolidation (something in lungs besides air

can be bacterial (community, nosocomial, aspiration), viral, mycoplasma

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16
Q

Atelectasis

A

partial or complete collapse of lung

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17
Q

_____ can lead to aspiration pneumonia

A

dysphagia

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18
Q

Dysphagia

A

difficulty swallowing, can lead to aspiration pneumonia

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19
Q

How can we prevent aspiration?

A

NPO
Positioning, semiupright in bed with HOB >30 (semi-fowler and fowler’s)

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20
Q

Clinical Presentation of Bacterial pneumonia

A

abrupt onset of high fever
chills, cough with purulent sputum
chest pain, dyspnea, myalgias, malaise, tachycardia
altered mental status in elderly

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21
Q

Diagnosis and Treatment of Bacterial Pneumonia

A

DX: hx, physical exam, chest xray, blood cultures, sputum culture, WBC count
Treatment: ABX, bronchodilators, airway clearance techniques

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22
Q

Outcome of bacterial pneumonias

A

Good in young and middle-aged, little or no permanent defect

elderly can die, 30-50% in bacteremic pneumonia. Harder to diagnose

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23
Q

Clinical presentation & Diagnosis of Viral pneumonia

A

S/S: fever, dry cough, myalgias, tachypnea, flu-like symptoms, scattered crackles, hypoxemia
DX: History, PE, CXR

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24
Q

Treatment and Outcome Viral Pneumonias

A

Treatment: symptomatic, no ACTs

Outcome: usually resolvles w/out complications or lasting damage, mortality <5%.

Covid-19 is an example

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25
Pleurisy
inflammation of pleural lining of the lung with exudate formation into pleural cavity (pleural effusion) secondary to pneumonia pleural infection w/TB or influenza Secondary to other systemic illnesses
26
Pleurisy Clinical Presentation
Chest pain due to edema referred to chest wall, abdomen, upper trap, shoulder Cough, fever, tachypnea
27
Diagnosis and Treatment of Pleurisy
Dx: History & PE pleural friction rub. splinting area of pain may decrease discomfort Tx: time, NSAIDs, other analgesics
28
TB Etiology
acquired by inhalation of m. tuberculosis in aerosols & dusts airborne transmission extremely efficient, droplets are sprayed by infectious individuals thrives in crowding, poverty, poor nutrition
29
Primary Infection of TB
latent TB infection -transient bacteremic phase brought under control by host immune system -mild symptoms or asymptomatic -lung lesion and enlarged lymph nodes walled off (granuloma)
30
Secondary active TB infection clinical presentation
TB disease, active TB lapse in immune competence allows reactivation of dormant mycobacteria any organ can be affected, lungs are the most due to high PO2
31
Dx and Tx of TB
DX = history, PE, CXR, sputum Tx: anti-TB drug combo (isoniaxid, rifampin, ethambutol
32
Outcome and Prevention of TB
Outcome: modern cure rates are high. Development of multi-drug resistant TB (low compliance), TB is leading cause of people with HIV Prevention: improved social conditions, immunizations, wear appropriate PPE
33
Tuberculosis Risk Factors
HIV Diabetes Substance abuse Homelessness Migrant workers healthcare workers jails nursing homes
34
COPD
preventable and treatable disease airflow limitation that is progressive reaction to noxious particles or gases chronic airflow limitation caused by mixture of small airway disease and parenchymal destruction
35
How does airflow obstruction occur in COPD?
Inflammation within airways Mucus obstructs airways Remodeling/scarring airways collapse due to damaged parenchyma
36
How is COPD diagnosed?
S/S: shortness of breath, chronic cough, sputum RF: host factors, tobacco, occupation, pollution Spirometery: required to establish dx other tests: CXR, ABGs, CBC/increased HcT
37
Clinical Features of COPD
40s to 50s with cough or acute chest illness dyspnea on exertion Hx of episodic wheezing and dyspnea CXR: hyperinflated lungs, flat diaphragm, enlarged right ventricle
38
Risk factors for COPD
Environment Host
39
Environment for COPD
Tobacco smoke Occupational exposure Indoor/outdoor air pollution infections poverty
40
Pack-year
1 pack per day x 40 years 2 packs per day x 20 years
41
Host and COPD
Genetic predisposition specific gene abnormality (antitrupsin deficiency) aging (increased females early lung development
42
____ is required to make a diagnosis of COPD
spirometry
43
FEV levels and COPD
FEV1/FVC <.70 confirms persistent airflow limitations
44
COPD Treatment Goals
Reduce Symptoms = reduce airflow obstruction, improve ex tolerance, improve QOL Limit disease progression = prevent and treat exacerbations, reduce mortality
45
5 As of smoking cessation
Ask = identify tobacco users Advise = 3 minute counseling session Assess = determine willingness to quit Assist = aid pt in quitting Arrange = schedule f/u contact
46
5 Rs of smoking cessation
Relevance--help pt identify why quitting is relevant now Risks--encourage them saying negative outcomes Rewards--help pt identify benefits Roadblocks--help identify obstacles in quitting Repetitions--take more than 1 time to quit
47
Medications for COPD
does not stop long term decline in lung function goals are instead to prevent/control symptoms, reduce frequency of exacerbations, improve ex tolerance
48
Drug classes for COPD
Bronchodilators Glucocorticoids Supplemental O2
49
Bronchodilators
prn or regular use reduce airflow obstruction B2 adrenergic agonists, anticholinergics, methylxanthines
50
Glucocorticoids
short-term use only prednisone
51
Supplemental O2
improve hemodynamics, lung mechanics and survival usually for severe COPD pts with PaO2 thats less than 55
52
Treatment Options for COPD
Reduce risk factors Drug classes for COPD Surgery for COPD Pulmonary Rehab
53
Surgery for COPD
Bullectomy = removal of large distended portion of lung Lung transplantation = only in very advanced and select cases
54
Pulmonary Rehab
for improvement in dyspnea, health status, and QOL in stable pts, reducing symptoms of anxiety and depression
55
COPD Prognosis
w/out smoking cessation, lungs will continue to lose function peripheral skeletal muscle dysfunction, muscle wasting, osteoporosis are also possible conditions. be cautious with positioning and spinal mobs
56
Blue bloater is known as
chronic bronchitis
57
Pink puffer is known as
emphysema
58
Barrel-chested
describes the rounded, bulging chest that resembles shape of barrel not a disease, may indicate underlying condition
59
Chronic bronchitis
chronic inflammation of bronchi/bronchioles. increased tracheobronchial mucus production sufficient to cause a cough producing sputum on most days for 3 months during consecutive years blue bloater
60
Pathogenesis of chronic bronchitis
increased size of tracheobronchial mucus glands and increased mucus production decreased # of cilia bronchoconstriction due to irritation in tracheobronchial tree
61
How to improve exercise tolerance in chronic bronchitis
hydration airway clearance techniques ventilatory strategies smoking cessation prevention of infections maintain healthy immune system
62
Emphysema
abnormal permanent enlargement of airspaces distal to terminal bronchioles accompanied by destruction of alveolar walls can be centrilobular (more common) or panlobular pink puffer
63
Pathogenesis of emphysema
inflammation, edema, thickened bronchiolar walls lungs become hyperinflated, enlarged air space in parenchyma bullae = spaces greater than 1 cm form that allow air in but not out
64
How to improve exercise tolerance for emphysema
ventilatory strategies teach energy conservation techniques teach breath control (pursed lip breathing) infection control flu shots hydration and nutrition
65
Pores of Kohn
interalveolar connections pausing at top of breath allows for air to disperse through alveoli
66
Cor pulmonale
right ventricular failure. causes edema (blue bloater)
67
Summary of Emphysema
60 yr old+ severe dyspnea scanty/mucoid sputum not frequent infections hyperinflation, bullae normal PaCO2, low PaO2, low hematocrit rare for cor pulmonale severely decreased elastic recoil
68
Summary of Chronic Bronchitis
+50 yr olds mild dyspnea copious, purulent sputum frequent infections large heart increased PaCO2, low PaO2, increased hematocrit common cor pulmonale normal elastic recoil
69
Bronchiectasis
abnormal dilation and anatomical distortion of medium sized bronchi and bronchioles, associated with previous chronic necrotizing infection w/intervention, pts can expect normal life expectancy
70
Pathogenesis of bronchiectasis
obstruction of airways and recurrent respiratory infections mucosa destroyed, replaced by scar damaged bronchi become permanently dilated and distorted recurrent infections, cystic fibrosis, TB, fungal infections, kung abscesses, pneumonia
71
Clinical Presentation of Bronchiectasis
chronic productive cough dyspnea and tachypnea increased PCO2, decreased PO2 FINGER CLUBBING
72
Treatment Bronchiectasis
IV fluids IV/oral ABX hydration Chest PT and other ACTs education
73
Strategies to improve ex tolerance, Bronchiectasis
Hydration ACTs proper medication use, frequent ABX use surgical lung resection
74
Cystic Fibrosis
genetic disorder inherited in autosomal recessive pattern. characterized by widespread abnormalities of all exocrine glands w/pathology in bronchial mucus glands, exocrine glands of pancreas, sweat glands
75
Clinical Presentation of CF
productive cough proliferative sputum production decreased ex tolerance recurrent hemoptysis (bloody cough) steatorrhea (oily stools)
76
Dx of CF
New born genetic screening test sweat chloride test hypoxemia, respiratory acidosis, mixed obstructive/restrictive pattern on labs eval at CF care center
77
Treatment options for CF
ideal place to receive treatment is at a CF care center education, bronchodilators, ACTs, exercise, pancreatic enzyme replacement, nutritional support, antibiotics, mucus thinners, modulators, lung transplantation
78
Prognosis of CF
highly variable presentation and severity life expectancy has begun to increase
79
Strategies to improve exercise tolerance, CF
hydration pancreatic enzymes to promote fat digestion and improve nutrition aggressive ACTs respiratory muscle training strength and endurance ex
80
Asthma
chronic inflammatory disorder of airways, characterized by increased responsiveness of airway smooth muscle to various stimuli. narrowing of airways reverses either spontaneously or due to treatment
81
Epidemiology of Asthma
higher in boys, higher in women african americans have more attacks low income families higher and worst incomes in rural
82
Asthma triggers
Allergic: pollen, animal dander, feathers, molds, dust, food Nonallergic: air pollution, weather, infections, medications, emotions, exercise
83
Pathogenesis of Asthma
1.some stimulus triggers cascade inflammatory cell migration, activation. 2.process is multicellular--> mast cells, eosinophils, t-lymph, macrophages, neutrophils 3.repetitive inflammation increases bronchial hyper-reactivity 4.during acute asthma attack, lumens of airways are narrowed by combo of muscle spasm, inflammation, mucus overproduction
84
3 S's of asthma
spasm swelling secretions
85
Presentation of acute asthma attack
increased work of breathing and use of accessory muscles tachypnea audible wheezing in expiratory phase dry cough chest tightness waking at night
86
Dx of asthma
no single universally accepted test history, spirometry (improvement in FEV1 by 12-15%), peak expiratory flow rate
87
Exercise-induced asthma
transient airway obstruction occurring. also called bronchospasm. during or after exercise. usually does not involve inflammation and mucus formation symptoms include wheezing, coughing, SOB, chest discomfort
88
Pathophysiology of EIB
1. bronchial hyper-reactivity most likely initiated by loss of airway surface liquid 2.air are humidified in conducting zone, results in cells losing water. after exercise is done, influx of water restores osmolarity 3.bronchospasm is triggered by loss of heat/water from airway
89
Diagnosis of EIB
pt self-reported symptoms spirometry (pre and post exercise PFT) 10-15% decrease in post-exercise FEV1
90
Triggers for EIB
hyperventilation respiratory heat loss (cold air) increased osmolarity caused by respiratory water loss (dry air)
91
RF for EIB
80-90% of those diagnosed with asthma winter sport athletes
92
Prevention of EIB
Good control of asthma Pre-exercise prevention gentle, intermittent warm-up promote nasal breathing vary exercise duration incorporate proper cool down ex in warm humid environment
93
Good control of asthma
controller medications may not prevent EIB peak flow meter to measure amount of air flow in one fast, hard exhalation (peak expiratory flow rate)
94
Pre-exercise prevention for EIB
take 20-30 minutes before exercise to take short-acting bronchodilator. mast cell stabilizer, prevents histamine release
95
What to do during an asthma attack?
stop an activity use rescue inhaler = short acting bronchodilator sit up call 911 continue to use rescue inhaler if S/S improve
96
Goals for asthma treatment
-Control for chronic respiratory S/S -appropriate medication intervention, Controllers & Relievers -minimize use of rescue inhalers -patient education -ex symptom-free -review status frequently
97
Asthma Action Plan
everyone with asthma needs their own action plan goal is to prevent and control asthma attacks, HCP works w/pt to create plan. Typically has a green, yellow, red level
98
Relievers
relieve acute bronchoconstriction taken on as needed basis may supplement controllers relaxes smooth muscle increase airflow types: 1. short acting beta adrenergic agonists (albuterol) 2. oral glucocorticoids (at hospital)
99
Controllers
provide long-term control by decreasing inflammation. taken daily, foundation for asthma management types: inhaled glucocorticoids, leukotriene modifiers, long-acting Beta adrenergic agonists (salmetrol)
100
Short-acting relievers
albuterol prednisolone prednisone
101
Long-acting anti-inflammatory controller
salmeterol, beta 2 agonist
102
Inhaled glucocorticoid
CONTROLLER most effective, potent, and frequently used anti-inflammatory asthma meds fewer ADRs and shorter onset of action time than oral form improves pulmonary function w/long term use.
103
Actions of Inhaled glucocrticoid
inhibit multiple segments of asthmatic cascade suppress generation of cytokines decrease population of airway eosinophils prevent inflammatory mediator release
104
Leukotriene modifiers
oral long-term control and prevention of symptoms protect against EIB decrease needed dose of inhaled glucocorticoid anti-inflammatory block leukotriene receptors in airways which are involved in inflammatory
105
Long acting Beta agonists
decrease frequency and intensity of asthma exacerbations may be used as supplement to inhaled glucocorticoids some provide prophylaxis against EIB for up to 8 hr actions: bronchodilation--effective up to 12 hours, increase expiratory flow rate
106
Strategies we can teach to improve ex tolerance and asthma
coordinate activities w/inhalers evaluate and instruct in proper use of MDIs warm-up and stretch active muscles and chest wall slow initiation and pacing, energy conservation ventilatory strategies incorporate cool down hydration
107
Prognosis of asthma
variable disease course reversible w/meds and respiratory therapy untreated = damage early detection is imperative